Carcinoma of the gallbladder: an appraisal of surgical resection

After the development of hepatobiliary imaging modalities and surgical procedures, we reappraised the effect of surgical treatment on the prognosis of gallbladder carcinoma.

Records of 32 patients with gallbladder carcinoma who underwent surgical resection between 1982 and 1992 were examined according to the pTNM staging system, and patients' prognoses were analyzed in relation to pathologic staging and surgical procedures.

The standard operative procedure was extended cholecystectomy (cholecystectomy plus hepatic resection [wedge or anatomic segmentectomy] plus en bloc lymph node dissection) with or without extrahepatic bile duct resection, and this was performed in 63% of cases. The actual 5-year survival rate of patients whose postoperative period was more than 5 years was 53%. The standard operative procedure gave satisfactory results for nine patients with stage I or II disease because all except two patients who died of other diseases were still alive more than 3 years after operation and there were five (56%) 5-year survivors. At stage III with pN1a lymph node metastasis, 50% of patients survived more than 5 years. However, in patients with pN1b or distant organ metastases, none survived more than 3 years even after more aggressive operation including hepatectomy plus pancreatoduodenectomy.

Complete removal of microscopic spread to the liver, bile duct, and lymph nodes is a great advantage to patients with gallbladder carcinoma at stages I and II and to those at stage III even in the presence of lymph node metastasis in the hepatoduodenal ligament.